Absorbable antibiotic beads as an adjuvant therapy in treating ventricular assist devices driveline infection: A case report.

BACKGROUND: Ventricular assist devices driveline infections are common, recalcitrant, and carry high morbidity and mortality. Herein, we reported a patient with driveline infection that was successfully treated with a combination of systemic antibiotics, surgical debridement, and instillation of absorbable antibiotic beads to the wound bed. METHODS AND RESULTS: A 39-year-old man with nonischemic cardiomyopathy underwent insertion of a continuous flow left ventricular assist device. Four years postoperatively, the patient presented with clinical, laboratory, and radiologic signs of driveline tract infection. He underwent extensive surgical debridement, installation of absorbable antibiotic beads that consisted of calcium sulfate, vancomycin, and tobramycin, into the wound bed, and systemic antibiotics. The patient was free of infection 9 month postoperatively. CONCLUSION: Absorbable calcium sulfate antibiotic beads may serve as a beneficial adjunct to surgical debridement and systemic antibiotics for the treatment of ventricular assist device driveline infection, and merit further investigation.

In Silico Prediction of the Absorption and Disposition of Cefadroxil in Humans using an Intestinal Permeability Method Scaled from Humanized PepT1 Mice.

It is difficult to predict the pharmacokinetics and plasma concentration-time profiles of new chemical entities in humans based on animal data. Some pharmacokinetic parameters, such as clearance and volume of distribution, can be scaled allometrically from rodents, mammals, and nonhuman primates with good success. However, it is far more challenging to predict the oral pharmacokinetics of experimental drug candidates. In the present study, we used in situ estimates of intestinal permeability, obtained in silico and from rat, wild-type (WT), and humanized PepT1 (huPepT1) mice, to predict the systemic exposure of cefadroxil, an orally administered model compound, under a variety of conditions. Using the GastroPlus simulation software program (Simulations Plus, Lancaster, CA), we found that the C max and area under the plasma concentration-time curve from time zero to the last measurable concentration of cefadroxil were better predicted using intestinal permeability estimates (both segmental and jejunal) from huPepT1 than from WT mice, and that intestinal permeabilities based on in silico and rat estimates gave worse predictions. We also observed that accurate predictions were possible for cefadroxil during oral dose escalation (i.e., 5, 15, and 30 mg/kg cefadroxil), a drug-drug interaction study (i.e., 5 mg/kg oral cefadroxil plus 45 mg/kg oral cephalexin), and an oral multiple dose study [i.e., 500 mg (6.7 mg/kg) cefadroxil every 6 hours]. Finally, the greatest amount of cefadroxil was absorbed in duodenal and jejunal segments of the small intestine after a 5 mg/kg oral dose. Thus, by combining a humanized mouse model and in silico software, the present study offers a novel strategy for better translating preclinical pharmacokinetic data to oral drug exposure during first-in-human studies.

[Current role of aminoglycosides in the treatment of acute pyelonephritis]. / Place actuelle des aminoglycosides dans le traitement des pyélonéphrites aiguës.

In view of the very great efficacy of 3rd generation cephalosporins and fluoroquinolones used as monotherapy in the treatment of uncomplicated acute pyelonephritis, the addition of an aminoglycoside is not currently recommended, because of the unfavourable balance of the advantages and disadvantages of this antibiotic class. However, a brief course of aminoglycosides may nevertheless be useful during the initial phase of treatment, especially in hospitalised subjects. The authors analyse the contribution of three recently published studies to this debate.

Eficacia del cefadroxilo oral como profilaxis antibiótica en heridas de extremidades ocasionadas por arma de fuego de baja energía / Efficacy of the ceffadroxil how antibiotic prophylactics in wounds of extremities caused by low energy of firearms

Se presenta el estudio realizado en 30 pacientes que ingresaron a un hospital del área metropolítana de Caracas por presentar heridas en las extremidades, que fueron ocasionadas por arma de fuego de baja velocidad; en ningún caso se encontró afección articular ni neurovascular. El grupo se constituyó por 25 sujetos masculinos y cinco femeninos, con edad promedio de 23.8 años. Al ingresar al hospital se les realizó cura local y desbridamiento mínimo de las heridas. Dieciseis de los individuos presentaron fracturas incompleta de algún hueso largo, que ameritó inmovilización con férula o vendaje circular de yeso abierto en la zona de la herida. El cefadroxilo (Bidroxyl) se administro por vía oral durante seis días, en dosis de 1g dos veces al día los dos primeros y 500 mg dos veces al día los cuatro restantes. El 93.33 por ciento de los pacientes (28/30) evolucionó favorablemente sin manifestar infección. Los dos sujetos adicionales (6.66 por ciento) presentaron abscesos, los cuales fueron tratados con base al cultivo y antibiograma. Se concluyó que el cefadroxilo oral es una buena alternativa como profilaxis antibiótica para heridas no complicadas de extremidades, que fueron ocasionadas por arma de fuego en pacientes ambulatorios. Sin embargo, se requieren más estudios multicéntricos para fortalecer este concepto

Efficacy of a twice-daily regimen of cefadroxil in the treatment of respiratory tract infections.

This multicentre open study evaluated the responses of 474 adult and paediatric patients with upper or lower respiratory tract infections to treatment with cefadroxil (25 to 50 mg/kg in children and 500 mg to 1 g in adults) twice daily for 10 to 30 days. Complete or partial cures seen in 81% to 100% of all patients correlated with the eradication of 87% to 100% of the causative pathogens, most commonly beta-haemolytic streptococci, S. aureus or S. pneumoniae. Mild, transient side effects, usually gastrointestinal disturbances or hypersensitivity reactions, were reported in 4.8% of patients. Thus, the safety and efficacy of this oral cephalosporin recommends its use in the treatment of infections of the respiratory tract.